Organization of cervical cancer screening with DNA-HPV testing impact on early-stage cancer detection: a population-based demonstration study in a Brazilian city

Abstract

Background: Cervical cancer is a preventable disease, and the Brazilian screening is opportunistic and has low impact. The current study evaluated an initiative to organize screening using DNA-HPV testing as a replacement for cytology.

Methods: This demonstration study examined information from 16 384 DNA-HPV tests for screening in women aged 25-64 years from Indaiatuba city between October 2017-March 2020. The comparison was 20 284 women screened using cytology between October 2014-March 2017. The flowchart indicates the repetition of a negative test in five years. HPV16- and/or HPV18-positive tests and the 12 pooled high-risk HPV-positive tests with abnormal liquid-based cytology were referred for colposcopy. If cytology was negative, the HPV test was repeated in 12 months. The analyses evaluated coverage, age-group compliance, and cancer detected.

Findings: After 30 months, the coverage projection was greater than 80%. The age compliance for the HPV test was 99.25%, compared to 78.0% in the cytology program. The HPV test program showed 86.8% negative tests and 6.3% colposcopy referrals, with 78% colposcopies performed. The HPV testing program detected 21 women with cervical cancer with a mean age of 39.6 years, and 67% of cancers were early-stage compared to 12 cervical cancer cases detected by cytological screening (p=0.0284) with a mean age of 49.3 years (p=0.0158), and one case of early-stage (p=0.0014).

Interpretation: Organizing cervical cancer screening using DNA-HPV testing demonstrated high coverage and age compliance in a real-life scenario, and it had an immediate impact on cervical cancer detection at an early-stage.

Funding: University of Campinas, Indaiatuba City, and Roche Diagnostics.

Keywords: Pap smear, DNA-HPV test; Papillomavirus infections; cancer screening; cervical cancer; public health.

Figure 1

The cumulative number of screening HPV tests performed in the first 30 months of the program (bars; total tests = 16 384). For reference, the lines represent the projected cumulative population coverage for 5 years: 80% coverage (full/green line) and 100% coverage (dotted/red line). Population considered: public health system women users (50%) aged 25–64 years from the official 2019 population estimate .